ArticleJournal of medical Internet research2019
A Protocol-Driven, Bedside Digital Conversational Agent to Support Nurse Teams and Mitigate Risks of Hospitalization in Older Adults: Case Control Pre-Post Study.
Article in Journal of medical Internet research, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
22 citing papers in PubMed, 3 syntheses or guidelines pooled it, 63 citations in OpenAlex.
- Interventions to reduce falls in hospitals: a systematic review and meta-analysis.Age and ageing · 2022Pooled it
- A Systematic Review on Healthcare Artificial Intelligent Conversational Agents for Chronic Conditions.Sensors (Basel, Switzerland) · 2022Pooled it
- Mobile health applications for older adults: a systematic review of interface and persuasive feature design.Journal of the American Medical Informatics Association : JAMIA · 2021Pooled it
- Effects of Emotional Expressiveness of a Female Digital Human on Loneliness, Stress, Perceived Support, and Closeness Across Genders: Randomized Controlled Trial.Journal of medical Internet research · 2021Trial
- Embodied Intelligence Applications in Health Care Populations: Scoping Review.Journal of medical Internet research · 2026Article
- Efficacy of artificial agents in loneliness alleviation among older adults: a protocol for a systematic review and meta-analysis.BMJ open · 2026Article
- How do consumers perceive virtual agents with behavioral realism? The role of loneliness and trust.Frontiers in psychology · 2026Article
- User Experience and Socioemotional Evaluation of Virtual Therapist Character Types in a Simulated Virtual Reality Exposure Therapy: Quantitative Study.JMIR XR and spatial computing · 2026Article
- Remote Virtual Interactive Agents for Older Adults: Exploring Its Science via Network Analysis and Systematic Review.Healthcare (Basel, Switzerland) · 2025Review
- Promoting Health Literacy With Human-in-the-Loop Video Understandability Classification of YouTube Videos: Development and Evaluation Study.Journal of medical Internet research · 2025Article
- Optimising the paradigms of human AI collaborative clinical coding.NPJ digital medicine · 2024Article
- Human-in-the-loop avatar chatbot shows promise in supporting hematopoietic stem cell transplantation patients.Bone marrow transplantation · 2024Article
- Evaluation framework for conversational agents with artificial intelligence in health interventions: a systematic scoping review.Journal of the American Medical Informatics Association : JAMIA · 2024Article
- RACares: a conceptual design to guide mHealth relational agent development based on a systematic review.mHealth · 2024Review
- A randomized, clinical trial investigating the use of a digital intervention to reduce delirium-associated agitation.NPJ digital medicine · 2023Article
- Design Validation of a Relational Agent by COVID-19 Patients: Mixed Methods Study.JMIR human factors · 2023Article
- A Mobile Application-Based Relational Agent as a Health Professional for COVID-19 Patients: Design, Approach, and Implications.International journal of environmental research and public health · 2022Article
- Article
- A Digital Human for Delivering a Remote Loneliness and Stress Intervention to At-Risk Younger and Older Adults During the COVID-19 Pandemic: Randomized Pilot Trial.JMIR mental health · 2021Article
- Overview and Strategy Analysis of Technology-Based Nonpharmacological Interventions for In-Hospital Delirium Prevention and Reduction: Systematic Scoping Review.Journal of medical Internet research · 2021Article
Corrections and comments
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Authors and funding
7 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundHospitalized older adults often experience isolation and disorientation while receiving care, placing them at risk for many inpatient complications, including loneliness, depression, delirium, and falls. Embodied conversational agents (ECAs) are technological entities that can interact with people through spoken conversation. Some ECAs are also relational agents, which build and maintain socioemotional relationships with people across multiple interactions. This study utilized a novel form of relational ECA, provided by Care Coach (care.coach, inc): an animated animal avatar on a tablet device, monitored and controlled by live health advocates. The ECA implemented algorithm-based clinical protocols for hospitalized older adults, such as reorienting patients to mitigate delirium risk, eliciting toileting needs to prevent falls, and engaging patients in social interaction to facilitate social engagement. Previous pilot studies of the Care Coach avatar have demonstrated the ECA's usability and efficacy in home-dwelling older adults. Further study among hospitalized older adults in a larger experimental trial is needed to demonstrate its effectiveness.
objectiveThe aim of the study was to examine the effect of a human-in-the-loop, protocol-driven relational ECA on loneliness, depression, delirium, and falls among diverse hospitalized older adults.
methodsThis was a clinical trial of 95 adults over the age of 65 years, hospitalized at an inner-city community hospital. Intervention participants received an avatar for the duration of their hospital stay; participants on a control unit received a daily 15-min visit from a nursing student. Measures of loneliness (3-item University of California, Los Angeles Loneliness Scale), depression (15-item Geriatric Depression Scale), and delirium (confusion assessment method) were administered upon study enrollment and before discharge.
resultsParticipants who received the avatar during hospitalization had lower frequency of delirium at discharge (P<.001), reported fewer symptoms of loneliness (P=.01), and experienced fewer falls than control participants. There were no significant differences in self-reported depressive symptoms.
conclusionsThe study findings validate the use of human-in-the-loop, relational ECAs among diverse hospitalized older adults.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.